Local health department efficiency: A data envelopment analysis

OBJECTIVES: Very little is understood about how efficiently Local Health Departments (LHDs) operate and deliver public health services. LHD operating costs vary widely across the nation, as does the number of public health services being provided to the community. Prior research has shown that most LHDs operated at an inefficiency level of 28% with some going as high as 69%, while only 14.4% achieved high efficiency. There is still much uncertainty around ideal LHD efficiency and what constitutes the optimal input and output level. This analysis seeks to understand how efficiently LHDs across the United States are delivering public health services.

METHODS: This study uses data envelopment analysis (DEA) to create an estimate frontier of LHD efficiency. DEA is frequently employed in determining ideal operation in other health care organizations, but is still a novel tool in public health. Inputs for the model consist of cost data from the 1997, 2005, and 2010 waves of the National Association of County and City Health Officials (NACCHO) Profile of Local Health Departments and data on public health services availability from the 1998, 2006, and 2012 waves of the National Longitudinal Survey of Public Health Systems (NLSPHS). The NLSPHS follows a nationally-representative cohort of local public health systems over time (n=397), profiling the availability of 20 core public health services within their jurisdictions, the organizations that deliver each, and the perceived effectiveness of services.

RESULTS: The analysis will show to what extent LHD efficiency, how many public health services they are providing with the smallest amount of inputs (costs), varies across our sample. In addition, we will capture the changes in efficiency at 3 time points (1998, 2006, and 2012).